流出道室性早搏／室性心动过速的导管消融疗效及体表心电图特征分析  

Catheter ablation and electrocardiogram characteristics of patients with idiopathic ventricular tachycardia/ premature ventricular contraction arising from ventricular outflow tract

作　　者：舒茂琴[1] 钟理[1] 冉擘力[1] 宋治远[1] 周扬[1] 刘燕[1] 朱平[1] 李华康[1] 张倩[1] 刘建平[1] 仝识非[1] 景涛[1] 

机构地区：[1]第三军医大学西南医院心血管内科,重庆400038

出　　处：《中华心律失常学杂志》2012年第5期352-356,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨三维电解剖标测系统（Carto系统）指导下导管消融治疗流出道室性早搏，室性心动过速（室早／室速）的疗效及体表心电图特征。方法对第三军医大学西南医院心内科2009年6月至2011年12月，Carto系统指导下行导管消融治疗的122例流出道室早／室速的临床和电生理资料进行回顾性分析。采用起搏及电激动标测，用冷盐水灌注导管行局灶消融。采用SPSS10．0统计学软件进行数据分析，两样本均数比较采用t检验；率的比较采用，检验；以P〈0．05为差异有统计学意义。结果①122例患者年龄15～66（39．2±9．4）岁，男68例，女54例。24例为特发性室速，98例为频发单源性室早；②起源部位分布：90例（73．8％）起源于右心室流出道（RVOT），其中74例起源于RVOT间隔部，16例起源于RVOT游离壁；肺动脉内起源2例；主动脉窦起源17例；左心室流出道（LVOT）起源13例，其中左心室游离壁3例、二尖瓣一主动脉瓣连接处4例、二尖瓣前侧壁4例及希氏束附近2例；③消融及随访结果：共计115例消融成功（成功率为94．3％），7例失败，1例合并高度房室阻滞。随访1～30个月，复发5例（复发率为4．3％），均再次消融成功。合并心律失常性心肌病12例，9例在术后3～6个月恢复正常。结论多数室早，室速起源于RVOT，LVOT和主动脉窦内起源者也不少见，Carto系统指导下冷盐水灌注导管消融有助于保证消融术的有效性和安全性。Objective To assess the clinical value of the electroanatomical mapping system（ Carto system） in the guiding of radiofrequency ablation of idiopathic ventricular tachycardia/premature ventricular contraction （1VT/PVC）arising from ventricular outflow tract and the characteristics of electrocardiogram. Methods Totally122 patients with IVT/PVC received the therapy from June 2009 to December 2011 at our center were retrospectively studied. Using voltage and activation maps guided by Carto mapping system, the originating sites of IVT/PVC were verified. Radiofrequency energy was delivered using irrigated-tip catheter. Results （1）A total of 68 males and 54 females at the age of（39. 2±9.4 ）years were involved in the study, being included in 24 patients with IVT and 98 patients with PVC. （2）The IVT/PVC originating：in 90 cases it was arising from right ventricular outflow tract（RVOT） ,in 13 cases it was arising from left ventricular outflow tract（LVOT） ,in 17 cases it was arising from aotic valvular sinus and in 2 cases above pulmonary valves. （3）Ablation results and follow-up：A total of 115 cases in 122 patients with IVT/PVC were successfully ablated （94. 3% ） at discharge, and in one case three degree atrial-ventricular block was observed. During the follow-up of 1 - 30 months ,the arrhythmia recurrence was found in 5 cases（4. 3% ） ,but re-ablation was successfully obtained in all 5 patients. Twelve patients had tachycardic myocardiopathy before ablation, but their heart structure and function recovery was observed after 3 - 6 months of ablation. Conclusion Most IVT/PVC originates from RVOT and three dimensional electroanatomic mapping system could be useful for effective ablation.

关 键 词：室性心动过速 室性早搏 电生理 导管消融 心室流出道 

分 类 号：R541.7[医药卫生—心血管疾病]